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NPI Code Detail

MEDICARE: DR. ABDULLAH K SALLAJ M.D.

MEDICARE:  DR. ABDULLAH K SALLAJ  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician036124109IL

General Provider Information

NPI Number : 1679739197
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ABDULLAH K SALLAJ M.D.
Provider Business Mailing Address
First Line : 561 W DIVERSEY PKWY
Second Line : SUITE 215
City : CHICAGO
State : IL
Zip : 60614-6068
Country : US
Telephone Number : 773-906-4546
Fax Number :
Provider Business Practice Location Address
First Line : 561 W DIVERSEY PKWY STE 215
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1682
Country : US
Telephone Number : 773-906-4546
Fax Number : 773-304-4549
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2008
Last Update Date : 11/13/2023

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